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Health Insurance for Seniors: Top 5 Things To Consider

Health Insurance for Seniors: Top 5 Things To Consider

Aubrey Moore on Sep 27th 2022

Things To Consider When Buying Health Insurance as a Senior.

two elderly ladies on beach laughing

Retirement can be an exciting time. As you transition into a new, slower-paced lifestyle, thinking about all the things you look forward to doing, whether spending more time with the grandkids or having more free time to travel, it's important to take care of your health.

You may feel young at heart with no health issues, but as you age, it's normal to develop health issues requiring medical attention, and while there are things you can do that will improve your health, you must have health insurance. Perhaps you've been on your employer's sponsored health insurance plan, and when you retired, you were taken off it. Or, maybe you've never had health insurance and were fortunate not to have faced any major issues.

Either way, as a senior, you must get the right cover so that you aren't in a bind should you need medical attention.

If you're buying health insurance as a senior, you must consider a few things.

1. Type of Health Insurance Plans

Medical Symbol

Health insurance can be divided into two main categories: public and private. Public healthcare isn't free but subsidized by the state and exists to give people who can't afford private health insurance access to healthcare.

Low-income folks under sixty-five qualify for Medicaid, and those over sixty-five can get onto the Medicare plan.

Many other health insurance plans are available to seniors, which fall under private health insurance. Private medical insurance is more expensive, but it is worth buying a private health insurance plan if you can afford the premiums.

Private health insurance plans are usually comprehensive and customizable so that you can tailor your plan to meet your medical needs.

When shopping for health insurance, choose a plan that covers the costs of annual medical checks, screenings, tests, and vaccines. Many plans include these preventative measures, which is helpful for seniors, who are more prone to falling ill and developing severe medical conditions.  Keep in mind that regardless of your insurance type. 99% will NOT cover the cost of a medical alert system as they do not consider it as a "medical necessity."  The good news is that our Medical Care Alert systems are very affordable with no long term contracts.

2. Co-payments and Deductible

You may be looking to pay the lowest amount possible in premiums, but before buying the cheapest option, read the fine print and take note of the co-payments and deductibles.

Often, the cheapest health insurance plans come with higher co-payments and deductibles, so you will be responsible for paying more every time you visit a health care provider.

Depending on your health care needs, paying for a higher premium with a lower co-payment and deductible amount may be more cost-effective.

Co-payment

A co-payment is a fixed amount you will have to pay every time you visit a healthcare provider or fill a prescription. Each plan has a different co-pay amount, but whatever it is, you will have to pay the amount stipulated in your plan, and the insurance will cover the bill's balance.

Deductible

If your health insurance plan has a deductible, you must pay for your healthcare and prescriptions every year until you reach the deductible amount. After you've reached it, your health insurance will kick in and cover your bills for the rest of the year. Still, you will be responsible for co-payments stipulated in your plan even after reaching the deductible amount.

Depending on your plan, you may be covered for preventive care and vaccines before you've paid the deductible.

3. Healthcare Network

ambulance and EMTEach medical insurance plan has a network of hospitals, doctors, and healthcare providers that they cover. Some may allow you to seek medical attention from a wide range of healthcare providers, while others have a much more narrow network, which can be quite restrictive.

Before buying health insurance, make sure that the plan you want to purchase covers health care providers and hospitals that are convenient for you to visit. If you plan on traveling or moving, you must consider where you will be and opt for a plan that covers a broader network.

Remember, changing insurance after enrollment is not always possible, so be sure to buy the right cover for at least a year.

4. Waiting Periods

Many medical insurance companies have waiting periods for pre-existing conditions. Conditions usually subject to waiting periods include diabetes and respiratory and cardiovascular issues.

If you were diagnosed with a medical problem before you joined the plan, the insurance wouldn't cover any expenses related to that condition during the waiting period. You will be responsible for paying these bills out of pocket.

In most cases, pre-existing conditions require immediate attention, so waiting out the waiting period isn't possible. If you have a pre-existing condition, search for a health insurance plan with the shortest waiting period so that you aren't burdened with the expenses for treatment.

5. Additional Perks and Benefits

Since medical insurance is expensive, you want to get the most out of it. Many health insurance companies offer additional perks and benefits to help you live healthier lives.

Some popular benefits include discounted gym memberships and wellness programs, free rides to medical appointments, counselling services, or access to chat with a medical professional twenty-four hours a day.

When comparing health insurance plans, ensure that the benefits included in the plan are ones you will use; otherwise, go for a cheaper option that covers your medical needs without frills you don't need. 

How Does Medicare Work?

If you're approaching or over 65 or disabled, understanding what's included and how to make the most of it is important!

Medicare is health insurance provided by the U.S. government for eligible people turning 65 or retiring. There are certain times people can sign up for Medicare and depending on the circumstances, some people may be enrolled automatically while others must apply manually. The first time you can enroll will be a 7-month period usually beginning 3 months before the month you turn 65, the month you turn 65, and will end 3 months after the month you turn 65. It is important to note that if you do not apply when you are first eligible for Medicare, you may have to pay a Part B late enrollment penalty, and have a possible gap in coverage if you decide to enroll in Part B later.

What Medicare Plans are There, and Which One is Right for Me?

Medicare includes two plans based on the needs of the person applying for insurance. Medicare Part A is hospital insurance and covers inpatient hospital stays, care in nursing facilities, hospice care, and some home health care. Medicare Part B is Medical Insurance which includes certain doctor’s services, outpatient care, medical supplies, and preventative services. It is recommended that most people enroll in Part A when they turn 65, even if they have previous health insurance.

Medicare Part A Plan:

This Medicare plan is targeted towards people who need hospital insurance. Talk to a doctor about your need for certain services or supplies and if Medicare will cover the cost of them for your care. Medicare coverage is based on federal and state laws, national coverage decisions made by Medicare, and local coverage decisions made by companies in each state on whether something is medically necessary and should be covered in your area.

Medicare Part B Plan:

Medicare Part B is targeted towards people who need Medical Insurance. Medicare Part B covers a “Welcome to Medicare” preventative visit within the first 12 months of your enrollment. If your doctor or health professional accepts assignment, you will pay nothing for this visit, and the Part B deductible does not apply. This visit is not a physical, but a time for your doctor or health care provider to get to know you and your needs. Medicare Part B is designed to prevent diseases and disabilities based on your current state of health and possible risk factors. Your health care provider will ask that you fill out a questionnaire called a “Health Risk Assessment” to help formulate a personalized prevention plan for you to maintain a healthy status.

The visit includes:

  •  A review of your medical and family history
  • Developing and updating a list of current providers and prescriptions
  • Height, weight, blood pressure, vision test, and other routine measurements
  • Screening of any cognitive impairment
  • Screenings for flu and pneumococcal immunization
  • Discussion on advance directives and screenings for potential risk of depression
  • Personalized health advice
  • A list of risk factors and possible treatments options for you
  • Advance care planning

It is important to note that any additional tests or services your health care provider performs in the same preventive visit may include a co-insurance or co-payment, and a Part B deductible may apply.

Medicare Part C Plan:

Also known as Medicare Advantage.

Medicare Part D Plan:


Prescription drug coverage.

Yearly Medicare Wellness Visits

If you’ve had Medicare Part B for longer than 12 months, you should schedule a yearly “Wellness” visit to update your health record and personalize a prevention plan. The wellness visit is designed to keep you healthy and prevent disease. Yearly Medicare Wellness visits also include a screening schedule for appropriate preventative services.

Preventative Services Include:

  • Cardiovascular- Done every 5 years
  • Breast Cancer Screening- Done every 12 months
  • Cervical and Vaginal Cancer Screening- Done every 24 months
  • Colorectal Cancer Screenings
  • Fecal Occult Blood test- Done every 12 months
  • Flexible Sigmoidoscopy- Done every 48 months
  • Screening Colonoscopy- Done every 120 months

Annual wellness visits are an important way to keep healthy and should be part of your fall prevention plan. 1 out of 3 seniors fall in their home each year, but with a Medical Care Alert Fall Detection Systemseniors can have peace of mind that help is on the way in the case of an emergency. Medicare generally does not pay for a Personal Emergency Response System, but some Medicare Advantage Plans do...check with your provider.

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